Geriatrics

So, I wasn’t sure how I wanted to fit such a broad subject into ONE small page, but wanted to address a couple of things….

*I will be summarizing information gathered from a range of lectures about geriatrics, neurological conditions and the use of cannabis. Lecturers include Eloise Theisen, NP and Deborah Malka, MD.

For these practitioners, the use of cannabis in older adults is really becoming popular. Dr. Malka reports that it is now about 50% of her practice! I think a big reason is because most people start experiencing symptoms as they age that respond so well to cannabis. Pain, depression, neurological impairment, insomnia, poor appetite, etc. To treat these symptoms, we put them on a poly-pharmacy of drugs which lead to MORE negative side effects. Am I wrong? Dr. Malka described a small study she participated in where they helped to initiate the use of cannabis to every member of an assisted living community. They all used CBD rich tinctures for various reasons (pain, mood, appetite, sleep) and MOST of them reported much improvement, while weaning OFF some of their other medications. Not that this is always the goal, but if a person can reduce drugs like opiates or seroquel that are sedating in nature………….. usually a good thing! Forgive my generalizations – each person’s story is unique and special of course 🙂

Geriatric Considerations

Any time an elderly person is taking medications, they need to be monitored! They have slower gut motility, slower metabolism, reduced bio-availability, potential renal/hepatic impairment and since CBD is processed in the liver, it may interfere with other medications. Warfarin levels for example will be slightly altered by cannabis. Adverse reactions can include an increase in heart rate, appetite, sleepiness, dizziness, dry mouth, change in mood, loose stools or constipation. It is important to know that these reactions are usually dose dependent and that many subside within a day or two, but it is imperative that the patient start with very low doses. Start low and go slow.

I also want to touch briefly on neurological deteriorating diseases:

Alzheimer’s for example is an unforgiving disease that affects millions! The number of those living with Alzheimer’s is projected to be approximately 14 million by the year 2050. Besides memory impairment, these individuals suffer mood disorders, apathy, depression, aggressive behavior, and decreased motivation. There is no cure at this time, only management strategies. Dementia, on the other hand can develop in the form of vascular dementia, which is related to chronic reduced blood flow to the brain and can cause both memory issues and movement or balance disorders. Dementia can also be in the form of frontotemporal dementia, which presents as a decline in behavior and language, often times resulting in a loss of insight, ability to function in society and can also include difficulty walking, muscle weakness, rigidity and tremors.

Cannabis is an amazing adjunct for these patients as it is a known neuroprotectant! Say what?? Yes – it can delay onset of a neurological disease and slow its progression. Although the government believes cannabis should be a schedule ONE drug with no known medicinal value they have patents on cannabis as a neuroprotectant. Hhmmmm….. It is now believed that THC, an antioxidant, actually prevents beta amyloid build up (and possibly reduces existing build up), which has been associated with alzheimer’s disease.

Remember that the endocannabinoid system already exists in our bodies and is made up of neuromodulatory lipids and their receptors. It maintains homeostasis in our systems and regulates mood, appetite, pain sensation and memory. Although the discovery of the ECS is fairly new (1990s), we are learning that these cannabinoid receptors are the most abundant receptors in our body and include CB1 receptors (nervous system, connective tissue, gonads, glands and organs) and CB2 receptors (immune system). It may be that many conditions that present as a disruption in our homeostasis (cancer, fibromyalgia, chronic pain, diabetes) is partially due to a deficiency in our ECS. Just something to ponder…..

Eloise presented a couple of case studies in her lecture that I found interesting:

1. 90 yo female diagnosed with MS, advanced dementia, chronic pain and close to being transferred from her assisted living to a memory unit. She had been on opioids for 40+ years and suffered falls, memory loss, aphasia, etc. Eloise started her on 2.5mg CBD/ 2.5mg THC twice a day and then 5mg CBD/ 5mg THC at night for sleep. After 3 months she was OFF her pain meds, functioning again, cognitively CLEAR and happy. She did NOT move and her daughter reported amazing changes.
2. 73 yo male with Parkinson’s and dementia – started show aggressive behavior and declining cognitively. He was started on 2.5mg CBD/ 2.5mg THC capsules 3X/day. He also improved drastically and was weaned off his seroquel.

Obviously, there is no cookbook technique to dosing people and their conditions because we are all so beautifully unique! People will respond differently! Again, I refer you to the professionals.

Lastly, I will leave you with some information specific to different ailments that are common in the elderly.

INSOMNIA – responds well to CBD/THC 2-10mg. Tinctures are made with various TERPENES. Myrcene is a great one for sleep.

CHRONIC PAIN – cannabis works synergistically with opiates (ok to take together AND will allow the patient to use LESS opiate with the same effect).

• nerve pain – responds well to cbd rich tinctures and THCa
• muscle pain – responds to a slightly higher ratio of THC:CBD
• Bone pain – CBD/THC, CBC (creams available)
• Inflammatory pain – CBD/THC and THCa

ANXIETY/ DEPRESSION – THC/CBD however dosing is KEY. Too much CBD can cause anxiety as it is a stimulant for many.

APPETITE/ WT LOSS – THC is most effective for appetite stimulant. Some females find CBD to be an appetite stimulant. If strains are high in THCV – it can decrease appetite.

Again – these are all broad generalizations. Humans along with their medical conditions and specific list of medications are just too unique to say that one dose of a particular cannabinoid fits all. Get with a professional.